The histopathologic spectrum of palisaded neutrophilic and granulomatous dermatitis in patients with collagen vascular disease

Interstitial Granulomatous Dermatitis Associated With the Use of Tumor Necrosis Factor α Inhibitors

“…Histological examination results demonstrate IGD characterized by a diffuse infiltration of the interstitium by histiocytes, piecemeal fragmentation of collagen, and the formation of small granulomas around degenerative areas in concert with variable numbers of polymorphonuclear leukocytes scattered within the infiltrate. Palisaded neutrophilic and granulomatous dermatitis was used in recent literature 16 as the favored term to unify the previously mentioned names and to designate an entity of unusual cutaneous manifestation of various collagen vascular diseases, so-called immune complex disorders. It has been postulated that the deposition of immune complexes in dermal vessels serves as the inciting event, followed by activation of the complement and neutrophils and subsequent damage to dermal collagen.…”

“…A granulomatous infiltrate is the secondary response to damaged collagen in the dermis. 16 Magro et al 17 Figure 2. A diffuse interstitial granulomatous infiltrate in the mid and deep dermis is shown (patient 1) (hematoxylin-eosin, original magnification ϫ40) (A); the infiltrate was composed of lymphocytes and histiocytes that palisade around incompletely degenerative collagen (patient 3) (hematoxylin-eosin, original magnification ϫ100) (B); histiocytes, lymphocytes, and eosinophils form discrete foci of granuloma surrounding partially degenerated collagen (patient 4) (hematoxylin-eosin, original magnification ϫ200) (C); and numerous eosinophils and scattered neutrophils are shown (patient 5) (hematoxylin-eosin, original magnification ϫ400) (D).…”

Acute-Onset, Painful Acral Granuloma Annulare

“…A variety of clinical presentations, including papules, plaques, or linear cords, often with a bilateral and symmetrical distribution, have been reported under a variety of monikers, including interstitial granulomatous dermatitis with arthritis, Churg-Strauss granuloma, palisaded neutrophilic and granulomatous dermatitis, rheumatoid papule or vasculitis, and, more recently, interstitial granulomatous dermatitis with plaques. [4][5][6][7][8] All of these conditions may clinically mimic generalized GA and are to be considered manifestations of a number of immunologically mediated diseases, including, but not limited to, rheumatoid arthritis, collagen vascular disease, Wegener granulomatosis, inflammatory bowel disease, and lymphoproliferative disorders. These conditions may also mimic GA from a histologic standpoint, although the diffuse interstitial pattern often exhibits numerous eosinophils, few to absent giant cells, and scant mucin deposition, in contrast to conditions found in GA. [4][5][6][7][8] The palisaded pattern, with the formation of basophilic necrobiotic zones containing neutrophils and neutrophilic debris with variable vascular fibrin deposition (or so-called ChurgStrauss granuloma), may more closely mimic GA histologically.…”

“…[4][5][6][7][8] All of these conditions may clinically mimic generalized GA and are to be considered manifestations of a number of immunologically mediated diseases, including, but not limited to, rheumatoid arthritis, collagen vascular disease, Wegener granulomatosis, inflammatory bowel disease, and lymphoproliferative disorders. These conditions may also mimic GA from a histologic standpoint, although the diffuse interstitial pattern often exhibits numerous eosinophils, few to absent giant cells, and scant mucin deposition, in contrast to conditions found in GA. [4][5][6][7][8] The palisaded pattern, with the formation of basophilic necrobiotic zones containing neutrophils and neutrophilic debris with variable vascular fibrin deposition (or so-called ChurgStrauss granuloma), may more closely mimic GA histologically. 8 The diffuse interstitial pattern was not seen in our patients' biopsy specimens, nor did their clinical presentation reveal the intertriginous and symmetrically distributed lesions typically noted in interstitial granulomatous dermatitis and other related disorders.…”

“…These conditions may also mimic GA from a histologic standpoint, although the diffuse interstitial pattern often exhibits numerous eosinophils, few to absent giant cells, and scant mucin deposition, in contrast to conditions found in GA. [4][5][6][7][8] The palisaded pattern, with the formation of basophilic necrobiotic zones containing neutrophils and neutrophilic debris with variable vascular fibrin deposition (or so-called ChurgStrauss granuloma), may more closely mimic GA histologically. 8 The diffuse interstitial pattern was not seen in our patients' biopsy specimens, nor did their clinical presentation reveal the intertriginous and symmetrically distributed lesions typically noted in interstitial granulomatous dermatitis and other related disorders. Although fibrin deposition and perivascular neutrophils were seen in the biopsy findings from patient 1, overt changes of vasculitis were not seen, and these findings have been reported in patients with GA.…”